How Basic Med Works!

by Dr. Bill Blank
Published in Midwest Flyer – August/September 2017 issue

I have been following “Basic Med” since the idea first arose, and waited to write this article until it was finally issued. I was afraid of last-minute changes which might lead to mistakes in the article.

Let’s be clear…the Federal Aviation Administration brought this on itself because of slow response times and sometimes overly conservative policies. Even today, the FAA sends letters to pilots requesting further information within 60 days without providing a phone number or email address at the bottom of the letter for questions! Yes, there are phone numbers, but they are hard to find. Many of the FAA staff and physicians are hardworking and conscientious, but the system does not work as well as it could and is slow to change.

Basic Med is a big change. In talking to pilots, I think that many do not understand the magnitude of the change. The same is true of some Aviation Medical Examiners (AME). We would not expect most non-AME physicians (“state licensed physicians”) to understand the FAA certification process. The real issue is what are the certification standards and who does the certification? More on that later.

Basic Med only applies to “pilots of certain small aircraft” (not more than six occupants or over 6000 lbs.). It really only applies to people who can fly with a third class medical. If the type of aircraft you fly or the type of operation you do requires a second or first class medical, that is still what you need. Third class medicals are also still issued.

The Basic Med “Comprehensive Medical Exam” can be performed by any state licensed physician (SLP). In most cases, it will probably be done by your primary care provider. It could be done by a pathologist, psychiatrist, cardiologist, radiologist, family physician, AME or any other SLP; the physician just needs to be willing to perform the comprehensive exam and sign the checklist. AMEs have to be state licensed. Physician assistants are not authorized to perform the exam.

Let’s go through the steps. The pilot goes online and prints out the Comprehensive Medical Exam Checklist (form 8700-2), completes the form, and takes it to the SLP. By contrast, if you were going to get an FAA flight physical, you would go to Medxpress, complete the form and submit it electronically. While you would take the Comprehensive Medical Exam Checklist to the SLP, the AME would receive the Medxpress form electronically. In each case, the physician would read what you had submitted and perform the exam.

The Basic Med form is essentially the same as the Medxpress 8500-8, but there are significant differences. Both forms start with your demographics – name, address, etc. There are questions about medications and “have you ever in your life had” various health conditions. In either case, the examining physician would ask you the reason for any medication you are taking and the presence of side effects. If so, that would be discussed further, along with the health conditions reported.

Now, pay attention; here is one of the big differences between the two types of exams.

I, as an AME, have a list of non-FAA approved medications. If you are taking one of these medications, I am not authorized to issue you a medical certificate. Because of potential medication side-effects or the underlying disease for which the medication was prescribed, the FAA wants to review the exam. The SLP is not under this restraint. The directions for the Comprehensive Medical Exam Checklist encourage the SLP to consult various FAA aeromedical publications. He is not required to do so or follow the recommendations. If, in his best clinical judgement, he does not feel that the medication or disease would impair the applicant’s ability to safely operate a motor vehicle or aircraft, he can sign the Comprehensive Medical Checklist.

The physical exam covers the same areas on each form. As an AME, I check normal or abnormal for each area examined. I must record blood pressure, visual acuity, etc., and must comment on every abnormal finding. The physician performing a Basic Med exam just checks “examined” for each area covered. He is not required to record anything else. If an AME encounters an abnormality, he may still be able to certify the pilot if he feels it is appropriate. If extra tests were required to justify this certification, the results would be forwarded to the FAA. The physician performing the Basic Med can also request additional information, but he is not required to put the results on the form.

I have frequently been asked if physicians will be willing to do Basic Med Comprehensive Exams. Some are already doing them. Some AMEs are doing them, too. I am not going to do them, but that is only because I am retired and want to do less, not more. If I were working full time, I would. One high-volume AME that I know (5000 flight physicals per year) uses the same standards as those of the third class medical exam. Other AMEs may not see the need do it that way. Perhaps a physician reading this article would want to place an advertisement in Midwest Flyer Magazine indicating his willingness to perform Basic Med exams. I think he would be busy and provide a valuable service.

When an AME signs your medical certificate, he is saying that he has followed FAA guidelines and you meet FAA standards. A physician signing your Basic Med Comprehensive Checklist is saying that he feels it is safe for you to operate a motor vehicle or certain small aircraft. He is using standards that he feels are appropriate. He, in all likelihood, knows motor vehicle standards. Remember, either physician is saying that he thought that you were fine when you walked out the door.

The other aspect of Basic Med is the requirement for the completion of an online medical course. I took the course so I could comment on it for this article.

I found that the course helps increase the awareness of many pilots about various medical conditions. This knowledge will be useful for one’s health in general, too. Most people, pilots included, probably don’t think much about these things until they become old enough to start having problems. Regardless of the type of medical certificate we have, we are required to self-certify ourselves each time we get into the cockpit. That is the last line of defense against medically-related aircraft accidents.

I hope this article helps you understand the Basic Med certification process. Basic Med will, I think, ease the certification process for many pilots. I don’t think it will lead to more medically-related accidents, and I hope I am right about that. State licensed physicians are not going to certify people they feel are not healthy enough to fly. It won’t, and it never was intended to be a way around regulations to certify people with serious medical conditions who should not fly.

EDITOR’S NOTE: William A. Blank is a physician in La Crosse, Wisconsin, and has been an Aviation Medical Examiner (AME) since 1978, and a Senior AME since 1985. Blank is a retired Ophthalmologist, but still gives some of the ophthalmology lectures at AME renewal seminars. Flying-wise, Blank holds an Airline Transport Pilot Certificate and has 5600 hours. He is a Certified Instrument Flight Instructor (CFII), and has given over 1200 hours of aerobatic instruction. In addition, Blank was an airshow performer through the 2014 season, and held a Statement of Aerobatic Competency (SAC) since 1987.

Pilots are encouraged to email regarding their ability or inability to find someone to do a Basic Med exam.

DISCLAIMER: The information contained in this column is the expressed opinion of the author only, and readers are advised to seek the advice of others, and refer to the Federal Aviation Regulations and FAA Aeronautical Information Manual for additional information and clarification.

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